ClotCare: Blood Clots, Stroke, Heart Attack
Sunday, October 13, 2024
Home   |   DVT/PE   |   Blood Clots   |   Coumadin/Warfarin   |   New Patients   |   Self Testing   |   Email List   |   Donate

Pick a Topic:

Find info on a:

We subscribe to the HONcode principles of the HON Foundation. Click to verify.
ClotCare complies with the HONcode standard for trustworthy health
information:
verify here.

ClotCare is a member of the Coalition to Prevent Deep Vein Thrombosis (DVT Coalition)  ClotCare is a member organization of the Coalition to Prevent Deep Vein Thrombosis. Click here to learn more about the Coalition to Prevent Deep Vein Thrombosis and DVT Awareness Month, which is held each March.

Can Protected Carotid Artery Stenting Replace Surgical Endarterectomy?

Susan C. Fagan, Pharm.D., BCPS, FCCP
November 2004

Review: Yadav JS, Wholey MH, Kuntz RE, Fayad P, Katzen BT, Mishkel GJ, Bajwa TK, Whitlow P, Strickman NE, Jaff MR, Popma JJ, Snead DB, Cutlip DE, Firth BG, Ouriel K. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med 2004;351:1493-1501.

The results of the SAPPHIRE trial were recently reported in N Engl J Med. This was an investigation comparing carotid endarterectomy (CEA) to carotid stenting and angioplasty with emboli protection in 334 patients who were at higher risk of complications from CEA than the patients that were included in the landmark trials (NASCET1 and ACAS2) supporting the safety and efficacy of CEA in patients with extracranial stenosis. Although stenting is used routinely in the care of coronary patients, the adoption of stenting in carotid artery disease has been slower because of technical difficulties with the procedure and the risk of embolization during the procedure. In this study, performed in 29 centers in the US, the primary endpoint was death, stroke or MI within 30 days or death or stroke between 31 days and 1 year after the procedure. Secondary endpoints included revascularization of the target vessel within 1 year.

The patients who had stenting had a lower risk of the primary endpoint (20 vs. 32), which was highly significant for noninferiority (p=0.004) and did not quite achieve significance for superiority (p=0.053). The increased incidence of occurrence of the primary endpoint in the CEA group was almost all accounted for by an increased 30 day MI rate in this group.

As expected, the stented group did not develop cranial nerve palsies and had shorter lengths of hospital stay (by one day).

The results of this study are good news for patients with cerebrovascular disease in that it is convincing that the technology for stenting in the cerebrovasculature is finally at the point where the procedure is safe and effective and definitely less invasive than CEA. Stenting is still not in a position to replace CEA as a first line intervention because of the small sample size and limited follow up time in this study (1 year). Investigators in the field expect this therapy to continue to evolve and improve as a viable way to prevent strokes in patients with extracranial stenosis. It even offers hope that intracranial stenosis may eventually be safely treated in this same manner, since the efficacy of antiplatelet and anticoagulant therapy still leave much room for improvement in the reduction of stroke in this group (WASID3).

References

1. North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med. 1991;325:445-453.

2. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Endarterectomy for asymptomatic carotid artery stenosis. JAMA. 1995;273:1421-1428.

3. Chimowitz MI, Kokkinos J, Strong J, Brown MB, Levine SR, Silliman S, Pessin MS, Weichel E, Sila CA, Furlan AJ.The Warfarin-Aspirin Symptomatic Intracranial Disease Study. Neurology. 1995 Aug;45(8):1488-93.

Ask a question about blood clots or anticoagulant medications Have questions? Ask ClotCare. Send questions by email to webmaster@clotcare.org.

ClotCare is a 501(c)(3) non-profit organization generously supported by your tax-deductible donations and grants from our industry supporters.

Blood Clot Activities Calendar

New Postings:

Click here to view full list of new postings
ClotCare Home | New Postings | Patient Postings | Clinician Postings | Join Our Email List | Useful Web Links
CE Opportunities | Training Programs | DVT & PE Stories | Editorial Board | Financial Support
About ClotCare | DVT Coalition | Donate to ClotCare | Contact Us
Key topics discussed on ClotCare include: Blood Clots | Deep Vein Thrombosis (DVT) | Pulmonary Embolism (PE) | Atrial Fibrillation (A. Fib or AF) | Heart Attack | Stroke | Transient Ischemic Attack (TIA) | Mini Stroke | Bleeding Complications | Vascular Surgery | Surgical Blood Clot Removal | Warfarin | Coumadin | Lovenox | Low Molecular Weight Heparin (LMWH) | Heparin | Anticoagulants | Plavix | Aspirin | Antiplatelets | Blood Thinners
Copyright 2000-2018 by ClotCare. All rights reserved.
Terms, Conditions, & Privacy | Image Copyright Information
19260 Stone Oak Parkway, Suite 101 | San Antonio, TX 78258 | 210-860-0487
Send comments to webmaster@clotcare.org.
Sunday, October 13, 2024